AB0439 COMPARATIVE EFFECTIVENESS OF RAPID AND CONVENTIONAL GLUCOCORTICOID TAPERING REGIMENS IN TREATING PATIENTS WITH PROLIFERATIVE LUPUS NEPHRITIS IN THE REAL WORLD SETTING
Authors: H. Shimizu, H. Oka, S. Sumitomo, M. Kanamori, C. Miyakoshi, A. Yoshimoto, H. Nishioka, K. Ohmura
Journal: Annals of the Rheumatic Diseases (2022)

Background Rapid glucocorticoid (GC) tapering is recommended for lupus nephritis (LN) by 2019 EULAR/ERA-EDTA recommendations [1]. However, slower conventional GC tapering regimen is still common in the real world setting, and it is controversial whether a rapid GC tapering regimen is as effective as the conventional regimen. Objectives We aimed to compare the renal outcomes between rapid and slower GC tapering regimens in patients with LN. Methods We retrospectively surveyed the medical records of 27 patients with proliferative LN (class Ⅲ or Ⅳ) at Kobe City Medical Center General Hospital. These patients were divided into two groups (rapid GC tapering group and conventional GC tapering group) according to GC dosage at month 6. Logistic regression analyses were performed to examine the association of GC tapering regimens with achievement of primary efficacy renal response (PERR) and complete renal response (CRR) which were defined by Furie et al. [2] at month 24. Results Twenty-seven patients (19 women and 8 men) with class Ⅲ or Ⅳ LN were included. The mean age was 43 years. The mean eGFR and urine protein-to-creatinine ratio at baseline were 66.7 mL/min/1.73m 2 and 3.125 g/gCr, respectively. Concomitant class Ⅴ LN was present in 26.0%. The rapid GC tapering group (PSL≦10 mg/day at month 6) and the conventional GC tapering group (PSL&gt;10 mg/day at month 6) were 11 and 16 patients, respectively. Baseline characteristics were balanced between the two groups except for use of cyclophosphamide or mycophenolate mofetil. Mean urine protein-to-creatinine ratio at month 24 were 0.46 g/gCr in the rapid GC tapering regimen group and 1.08 g/gCr in the conventional GC tapering regimen group (p=0.790). Achievements of PERR and CRR at month 24 were 54.0% and 43.8% in the rapid GC tapering group and 54.5% and 25.0% in the conventional GC tapering group, respectively. After adjustment of cyclophosphamide or mycophenolate mofetil usage and urine protein-to-creatinine ratio at baseline, adjusted odds ratio was 1.52 (95% confidence interval [0.126 to 18.29], p=0.743) and 2.99 (95% confidence interval [0.34 to 28.52], p=0.341), respectively. Conclusion Our results suggest rapid GC tapering regimen is as effective as conventional slower tapering regimen for patients with proliferative LN. References [1]Fanouriakis A, Kostopoulou M, Cheema K, et al. 2019 Update of the Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of lupus nephritis. Ann Rheum Dis 2020;79:713–723. [2]Furie R, Rovin BH, Houssiau F, et al. Two-Year, Randomized, Controlled Trial of Belimumab in Lupus Nephritis. N Engl J Med 2020;383:1117–1128. Table 1. Baseline patients characteristics. Rapid GC tapering group(n=11) Conventional GC tapering group(n=16) P value Age – years 41.7 ± 14.7 43.9 ± 16.2 0.863 Female – no. (%) 9 (81.8) 10 (62.5) 0.405 Class Ⅲ LN – no. (%) 6 (54.5) 7 (43.8) 0.704 Class Ⅳ LN – no. (%) 6 (45.5) 9 (56.3) 0.704 Concomitant Class Ⅴ LN – no. (%) 4 (36.4) 3 (18.8) 0.391 Induction therapy (use of CY or MMF) – no. (%) 10 (90.9) 8 (50.0) 0.042 Serum creatinine – mg/dL 1.15 ± 0.72 1.14 ± 0.80 0.882 eGFR – mL/min/1.73m 2 65.2 ± 39.0 67.8 ± 34.5 0.835 UPCR – g/gCr 3.29 ± 2.96 3.01 ± 3.25 0.604 C3 – mg/dL 41.1 ± 20.1 45.0 ± 21.5 0.639 C4 – mg/dL 6.8 ± 4.7 10.1 ± 8.0 0.346 GC, glucocorticoid; LN, lupus nephritis; UPCR, urine protein-to-creatinine ratio; CY, cyclophosphamide; MMF, mycophenolate mofetil Disclosure of Interests None declared